Federal views diverge on proper use of painkillers

How do you have a conversation about prescription drugs that provide critical pain relief to millions of Americans yet also cause more fatal overdoses than heroin and cocaine combined?

It's a trend closely monitored by the Drug Enforcement Administration, where officials say an oversupply of painkillers is fueling the black market for both prescription opioids and heroin.

DEA Deputy Assistant Administrator Joe Rannazzisi says it is "outrageous" that the U.S. consumes 99 percent of the world's hydrocodone — the most prescribed medicine in the country.

"A controlled substance shouldn't be the most widely prescribed medication in the United States," he said in an interview. "If we believe we're the only country that knows how to treat pain that's a pretty arrogant attitude."

To be sure, any successful effort to curb drug abuse must involve a wide range of players, including state lawmakers, medical boards, pharmacy chains and medical educators.

In her interview with the AP, Dr. Hamburg emphasized this multifaceted approach while highlighting two recent steps by the FDA to reduce harm from opioids.

In September, the FDA narrowed the prescribing label on long-acting opioids like OxyContin to specify that they should only be used for "pain severe enough to require daily, around-the-clock" therapy that cannot be managed with other approaches. Previously, the label simply stated the drugs were for "moderate to severe pain."

In October, the FDA recommended reclassifying hydrocodone-containing combination pills like Vicodin to limit how doctors can prescribe them.

But both of those actions came after outside pressure. The labeling change was in response to a petition from the physician group PROP, which sought much stricter labeling than what the FDA ultimately put in place. The change in classification for hydrocodone pills came after nearly a decade of prodding by the DEA, which argued that the drugs had been misclassified in the first place.

DEA's Rannazzisi says the difference in tone between various agencies reflects their unique missions. As he sees it, the FDA's primarily role is to review drugs and make sure they are marketed appropriately. But the DEA's mission to investigate drug diversion brings his staff much closer to the ongoing epidemic of abuse and addiction.

"Maybe sometimes people need to get out from behind their desks and actually go and look at what's going on," Rannazzisi said. "Because in the end this is a national tragedy that's not being addressed."